Posttraumatic Stress Disorder (PTSD) and War-Related Stress PTSD Posttraumatic Stress Disorder Posttraumatic Stress Disorder (PTSD) and War Related Stress PTSD The National Centre for War Related Posttraumatic Stress Disorder’s most recent publication, Posttraumatic Stress Disorder (PTSD) and War Related Stress provides a description of the nature of PTSD and related conditions in lay terms. Written by Mark Creamer and David Forbes from the National Centre for War Related PTSD and Grant Devilly from the University of Queensland the book incorporates a considerable number of insights from veterans with PTSD, their partners and counsellors from the Vietnam Veterans Counselling Service. It also offers commonsense hints for coping better with the condition and a description of what formal treatment may entail. To receive a free copy of Posttraumatic Stress Disorder (PTSD) and War Related Stress phone: (03) 9496 2922, email: [email protected] or visit www.ncptsd.unimelb.edu.au Copyright © 1999 Designed by Steven McIntosh Production: Words of Art Typefaces: Bodoni, Goudy Old Style and Times New Roman Frontpiece Ivor Hele Private John White 1941 crayon with charcoal 56 x 37.8 cm AWM.28483 All Photos and Artwork used with the permission of the Australian War Memorial ISBN: 0–642–41460–2 PTSD Posttraumatic Stress Disorder (PTSD) and War-Related Stress Information For Veterans And Their Families National Centre for War-Related Posttraumatic Stress Disorder The National Centre For War-Related PTSD. Locked Bag 1, West Heidelberg, Victoria 3081. Tel: (03) 9496 2922 Fax: (03) 9496 2830 Email: [email protected] Web: www.ncptsd.unimelb.edu.au The National Centre is a collaborative project between the Commonwealth Department of Veterans’ Affairs, The University of Melbourne, and the Austin and Repatriation Medical Centre. Posttraumatic Stress Disorder & War-Related Stress i MESSAGE FROM THE MINISTER Message From The Minister For Veterans’ Affairs In recent years, we have seen an increasing awareness of the emotional and psychiatric effects that traumatic events may precipitate. Such events may occur in civilian life, in the form of assaults, accidents, and Bruce Scott traumatic bereavements. They may occur in the work context, particularly in high-risk occupations such as the partners and families in helping them emergency services, overseas aid to understand their loved one’s reac- agencies, and financial institutions at tions and in knowing how to respond. risk of armed hold-up. Perhaps the most Specialised treatment programs are obvious examples, however, are the now available in every state of traumatic events that the men and Australia. If you are suffering from the women of our Defence Forces face on kinds of problems described in this our behalf. book, you may wish to think seriously The stress of military service has about getting some professional help. been identified under many names over Call your local VVCS Office or the the years, including shell shock, war National Centre for more information neurosis, and battle fatigue. In more (see the contact details at the back of recent times, the term posttraumatic this book). stress disorder, or PTSD, has been In the meantime, I hope you will adopted and considerable effort has find the information and advice con- been devoted to assisting veterans and tained in this book to be helpful and currently serving personnel suffering supportive. from this debilitating disorder. The Department of Veterans’ Affairs, through the National Centre for War-Related PTSD, has taken a lead role in helping veterans to recover from the stress of their military experiences. The Hon. Bruce Scott MP This booklet provides sound advice Minister for Veterans’ Affairs and practical suggestions to assist veterans who are experiencing PTSD Minister Assisting the Minister or related problems. It is useful also for for Defence Posttraumatic Stress Disorder & War-Related Stress iii HOW TO USE THIS BOOK Then move on to the next section. You How To Use will gain much more from the book if you read it slowly and carefully. If you This Book have a partner or close friend, you may wish to read it with him or her. Take it in turns to read a section and then discuss it – does it apply to you and your relationship? If so, is there anything you can do about it? When you have finished the book, This book was developed by mental you may decide that you would like health professionals with considerable to obtain some extra professional help. experience in the area of posttraumatic By then you will have a good know- stress. Although it is directed primarily ledge of traumatic stress and the at veterans and their families, the infor- kinds of things that treatment may mation is equally applicable to survivors involve. In the meantime, we hope that of other kinds of trauma. the information in this book will help A large amount of information and you understand your problems and how advice is contained in these pages and to begin the process of recovery. we recommend that you do not try to Remember, there is much that you can master it all in one go. Read a small bit do to improve your quality of life, your at a time and, if necessary, re-read it relationships, and the way you feel. several times until you understand it. Good luck! Light Horse Signallers at Tiberius (WW1) – AWM.B00277 iv Posttraumatic Stress Disorder & War-Related Stress ACKNOWLEDGEMENTS tance in the production of this book- Acknowledgements let. Staff and veterans from the PTSD treatment program at the Austin & Repatriation Medical Centre, and staff and veterans from VVCS Posttraumatic Stress Disorder: Queensland, for their suggestions on Information for Veterans and Their early drafts of the manuscript. Wes Families was produced by the Kilham and Ros Woodward from National Centre for War-Related VVCS Head Office for their critiques PTSD. It was written by Mark and comments. Staff from the Creamer and David Forbes (National Younger Veterans Program of the Centre), and Grant Devilly Department of Veterans’ Affairs for (University of Queensland). their assistance with the practicalities. The National Centre would like And, finally, Joanne Cesario and to thank several people for their assis- Terry Lewis from the National Centre for a host of other things. “The Original 11th Battalion, 3rd Brigade AIF, Egypt 1915 – AWM.A02875 Posttraumatic Stress Disorder & War-Related Stress v CONTENTS vi Posttraumatic Stress Disorder & War-Related Stress CONTENTS Contents How To Use This Book iv Acknowledgements v Background 4 What is PTSD? 5 What is a traumatic event? 6 Common Symptoms of PTSD 8 Intrusive symptoms 8 Avoidance symptoms 9 Arousal symptoms 10 Why do traumatic stress symptoms develop? 11 Associated Problems 14 Anxiety 15 Depression 15 Alcohol and Drugs 17 Impact on Relationships and Work 18 Family functioning 18 Occupational functioning 20 Coping 22 Coping yourself 22 Coping within a family 26 Sleeping better 28 Posttraumatic Stress Disorder & War-Related Stress 1 CONTENTS Contents Treatment 30 Stabilisation and engagement 31 Education and information 33 Symptom management 34 Exposure therapy: confronting feared situations 37 Exposure therapy: confronting the memories 38 Cognitive restructuring 40 Psychodynamic psychotherapy 41 Relapse prevention 42 Alternative and adjunctive treatments 42 Resources 43 The Vietnam Veterans Counselling Service 43 The National Centre for War-Related PTSD 44 Accredited PTSD treatment programs 45 Support groups 45 AWM.8257 2 Posttraumatic Stress Disorder & War-Related Stress BACKGROUND BACKGROUND Ivor Hele Australian Soldier, Libya 1941 oil on canvas 58.4 x 48.2 cm AWM.28474 Posttraumatic Stress Disorder & War-Related Stress 3 BACKGROUND has no simple answer. However, we Background know that between 12 and 15 percent of war-zone veterans – including peace-keeping forces – will go on to experience a chronic condition known as Posttraumatic Stress Disorder Whether in the military or as a (PTSD), while a further 12 to 15 civilian, at some point during our lives percent will experience at least some nearly all of us will experience a of the symptoms associated with this traumatic event that will challenge our condition. This booklet is aimed at view of the world or ourselves. providing information for veterans who Depending upon a range of factors, have developed some of the more com- some people’s reactions may last for just mon symptoms of PTSD. It is designed a short period of time, while others may to provide some suggestions as to what experience more long-lasting effects. veterans can do to help themselves and The question of why some what they can expect in the way of people are affected more than others treatment for this condition. Ivor Hele, Meteor Jet, 1952, oil on canvas on plywood, 40.4 x 45.6 cm – AWM.40326 4 Posttraumatic Stress Disorder & War-Related Stress WHAT IS PTSD? ed with PTSD during combat. In the What is PTSD? Vietnam War, this became known as a “combat stress reaction”. Some of these people continued on to develop what became known, in 1980, as PTSD is a psychological response to Posttraumatic Stress Disorder. the experience of intense traumatic Traumatic stress can be seen as part events, particularly those that threaten of a normal human response to intense life. It can affect people of any age, experiences. In the majority of people, culture or gender. Although we have the symptoms reduce or started to hear a lot more about it in disappear over the first few months, recent years, the condition has been particularly with the help of caring fam- known to exist at least since the times ily members and friends. In a of ancient Greece and has been called significant minority, however, the by many different names. It is referred symptoms do not seem to resolve quick- to often in literature and the work of ly and, in some cases, may continue to Shakespeare provides several good cause problems for the rest of the per- examples - some of these appear in this son’s life.